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Advanced Care Planning: A Quick Overview

One of the best things you can do for yourself and your loved ones is to proactively plan for the future when you are no longer able to speak and make a cognitive decision for yourself. This ensures that those close to you understand and align with your values, wishes, will, decisions, and preferences. These include decisions pertaining to:
●     finances, properties/estates and intended beneficiaries
●     decisions regarding your care (kind of care you wish to receive, preference for where to receive care and who can make decisions on your behalf)
●     spiritual, religious, cultural values and preferences
●     decisions and options for end of life including:
○     DNR (do not resuscitate) orders
○     refusal from medication, food and drink
○     palliative care to ease pain
Advanced care planning is an important process that helps ensure that individuals receive support for their finances and health care needs while living, that align with their values and preferences when they are no longer able to make decisions for themselves. The documents that help preserve and protect these choices include: a Power of Attorney (POA) and a person to represent their healthcare directives.
For family / friend caregivers, it’s important to remember, understand and respect that these tools and documents are put in place to protect the values and wishes of the person under their care. It is therefore important for family caregivers to honour these plans and recognize that this is crucial in upholding their loved ones’ autonomy and dignity.
These documents are intended to serve as a guide to alleviate potential conflicts among family members and healthcare providers. They are also put in place to help relieve caregivers of the burden of making difficult choices during emotionally challenging times. These person-centred care decisions extend from before, during and at the time the person takes their last breath. In the next section we will be sharing an overview of the 2 main documents needed in Canada. Please be sure to consult with professionals in your region.
What is a Power of Attorney (POA)?
A good resource to refer to in regards to this topic is the Government of Canada website as legal language as well as what is considered legally valid and acceptable varies by province. According to the Government of Canada website, a power of attorney is “a legal document that you sign to give one person, or more than one person, the authority to manage your money and property on your behalf.”
One crucial factor in assessing the legitimacy of a Power of Attorney is the individual’s mental state when they signed it. This involves demonstrating that they were mentally competent to comprehend the financial choices they were making and their potential outcomes. The legal definition of what constitutes “mental capacity” may differ depending on the province or territory.
Enduring or Continuing Power of Attorney
An Enduring or Continuing Power of Attorney is a legal instrument employed to grant another individual the power to manage financial and legal matters for an adult who has become mentally incapacitated and thus unable to handle such affairs. The scope of an EPA is confined to financial and property-related decisions, excluding authority over lifestyle choices, accommodations, or medical determinations.
What Your POA Can and Cannot Do
If you do not specifically state any restrictions on the authority of your POA, they have the ability to handle nearly all aspects of your finances and property including: perform banking transactions/signings cheques on your behalf; buying and selling real estate and consumer goods; and manage your investments and everything you own, including your home.
POAs cannot and do not have the power to: make or change your will, add and/or modify beneficiaries to your life insurance plan; and, give/assign a new POA. Finally, it’s important to note that while Powers of Attorney (POAs) oversee your finances and properties, they do not grant ownership rights to them.
Delegation of Authority on Healthcare and Personal Care Decisions
In Canada, you can grant an individual authority to make personal care and healthcare decisions on your behalf, in case you become mentally incapable of doing so. Depending on the province or territory you live in, these documents might be called differently, such as: powers of attorney for personal care, personal or health directives, representation agreements, or mandates.
Common Terms Used in Some Canadian Provinces
Below are some terms you may come across in regards to incapacity planning:
Representation Agreements
A representation agreement is a legal instrument allowing you to designate an individual, known as a “representative,” to assist you in making personal and healthcare decisions in the event that you are unable to do so yourself (excluding M.A.I.D or Medical Assistance in Dying).
Check with your province because there are circumstances where a person may not have a designated POA. In such cases, there could be an option for them to sign a form to appoint a person to have additional responsibilities, such as handling bill payments on their behalf.
Advanced Directives
An Advance Directive is meant for healthcare providers (or anyone providing care) with clear guidelines (i.e., directives) that they are obligated to adhere to should the person become incapable of making their own decisions. It is a legally binding document for healthcare providers regarding the medical treatments the person consents to or rejects in the event the person is unable to express their wishes when care is required.
Substitute Decision Maker (SDM)
Depending on which province you are located, substitute decision makers are also called, “medical proxy,” “health representative,” or “power of attorney for personal care.”2
It’s crucial to understand that most medical hospitals use a “priority list” to determine who can act on behalf of the patient when that person is no longer able to do it for themselves. This hierarchy typically begins with a parent or a spouse, and then an adult child or distant relative. This sequence is referred to if the patient has not appointed a representative or if their legal representative cannot be reached or located. It would be ideal to have all possible SDM to have a copy of any health directives.
As family caregivers who are designated as their loved one’s POA or health representative, the most important thing to remember is the principle and intent of these legal documents. Please be sure to seek proper legal advice from a professional in your province.
It is not an easy role to carry out, but the key thing to keep in mind is that this is your loved one’s last informed and cognitive wish and will which they have taken every effort to make known and have entrusted you to faithfully carry out. It is their final and remaining act of independence and autonomy. They may not be able to speak; and their wishes and needs may be in direct conflict with yours, but remember, even nearing death, it is about their life and their choices to honour, protect, respect and uphold. Doing so, you are honouring and showing love and respect for who they are.
Karen Tyrell CPCA, CDCP is a Dementia Consultant, Educator, Author & Advocate, and Founder of Personalized Dementia Solutions Inc. ( Karen offers her expertise on dementia care through speaking engagements; workshops; support groups (both online and in-person) and by working one-on-one with families/caregivers to provide emotional support and practical solutions. She was also on the design team for The Village Langley (Verve Senior Living) and provides ongoing education to the Village team, families and the community. If you would like to learn more, please feel free to reach out.
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.